Provider Demographics
NPI:1881015113
Name:FARHAT, ALICIA ELENA (MPH, RD, LD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:ELENA
Last Name:FARHAT
Suffix:
Gender:F
Credentials:MPH, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 LIBERTY ST APT 2812
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-8716
Mailing Address - Country:US
Mailing Address - Phone:225-588-9532
Mailing Address - Fax:
Practice Address - Street 1:1935 MEDICAL DISTRICT DR
Practice Address - Street 2:CLINICAL NUTRITION
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7701
Practice Address - Country:US
Practice Address - Phone:214-456-3264
Practice Address - Fax:214-456-6287
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1039352133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT82916OtherLICENSED DIETITIAN
1039352OtherREGISTERED DIETITIAN, REGISTERED DIETITIAN NUTRITIONIST